Private Sector Innovates to Eliminate Malaria in Cambodia

On this
World Malaria Day, it’s important to reflect on the major ground we’ve gained.
For example, in the last decade, Cambodia has achieved impressive results in
its fight against the disease — so much so that it is now one of the 17
countries in South East Asia aiming to eliminate malaria by 2025. But the
largest gains can often be madeby closing the smallest gaps.

Cambodia’s
National Strategy for Malaria Elimination stresses the need for early diagnosis
to detect all malaria cases, lest the problem once again grow to previous
proportions. The strategy relies on public and private sector providers
offering access to reliable diagnostics and high quality malaria treatment,
while simultaneously preventing the use of substandard drugs and monotherapies.
These steps are vital to ensuring that artemisinin-resistant parasites, which
threaten control and elimination gains with the prospect of untreatable
malaria, are not allowed to spread.

Indeed, the
spread of artemisinin-resistant parasites heightens the sense of urgency in the
fight against malaria and amplifies the need to detect and treat every single
case promptly and appropriately. To do this, it’s critical to reach
remote, high-risk populations with limited access to health services and inconsistent
treatment seeking behaviours. This means creatively pressing the private
sector — where 60% of antimalarial drugs are distributed in Cambodia — into
service.

Increasing demand for malaria case management services

Mobile
migrant workers in Cambodia run a greater risk of malaria infection than other
populations. Their work brings them to endemic forested areas – and they often
do not have access to preventive measures, such as insecticide-treated nets or
repellents. In addition, because of the overall decline in malaria cases in the
country, they rarely link their symptoms to malaria and forego treatment. When
treatment is sought, it is often
among informal providers who often prescribe a mix of drugs of unknown origin
and efficacy.

In order to
reach the remote populations of mobile workers and their families, Population
Services International-Cambodia (PSI-Cambodia) is implementing an innovative
project in partnership with the corporate private sector and the Gates
Foundation. Working with rubber plantation owners in northeast Cambodia,
PSI-Cambodia is operating across five provinces on 45 of the largest
plantations (with a plan to expand to 100 plantations in 8 provinces this year)
through a network of community health workers or Plantation Malaria Workers
(PMWs). Data collected in these plantations show that almost a third of tested
fever cases are malaria, highlighting the need to reach workers and their
families to ensure they are given a rapid diagnostic test and receive quality
treatment if positive.

To increase
treatment-seeking behaviour, PSI-Cambodia is launching an integrated delivery of
health services through PMWs, which offers the workers and their families free
deworming and diarrhea treatment, as well as condom distribution — all in
addition to malaria prevention, diagnosis and treatment. By offering a range of highly sought-after health interventions, the
project generates consumer demand, increases workers’ trust in PMWs and
improves perceptions of the PMWs added value.

Strengthening public-private partnerships

Effective
collaboration between the private and public health sectors is an essential
component of Cambodia’s malaria elimination strategy. This project uses a range
of technology solutions to assess the quality of care administered by PMWs, to
track actual malaria cases among high-risk populations in rubber plantations,
and ultimately share information with both regional and national authorities.

Teams using
tablet-based programming for supportive supervision have conducted over 130
quality assurance assessments to date. PMWs will soon use mobile phones to
upload caseload data to an integrated information system linked to the national
malaria reporting system. The newest programming will enable real-time data
sharing and options for analysis across decision-making tiers. Programs like
these are often the only option available to the public sector for integration
of private sector data into its own registry.

On the path
to eliminate malaria, no innovation can be left untested. But it’s likely
that no single innovation alone will turn the tide either. By integrating the
right partnerships, technologies and most important, an understanding of the
population we aim to treat, elimination can, indeed, be in our grasp.

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